CN104023648A - Surgical incision and closure apparatus with integrated force distribution - Google Patents
Surgical incision and closure apparatus with integrated force distribution Download PDFInfo
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- CN104023648A CN104023648A CN201280054111.XA CN201280054111A CN104023648A CN 104023648 A CN104023648 A CN 104023648A CN 201280054111 A CN201280054111 A CN 201280054111A CN 104023648 A CN104023648 A CN 104023648A
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- Prior art keywords
- panel
- cut closure
- tissue
- side direction
- cut
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Classifications
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/08—Wound clamps or clips, i.e. not or only partly penetrating the tissue ; Devices for bringing together the edges of a wound
- A61B17/085—Wound clamps or clips, i.e. not or only partly penetrating the tissue ; Devices for bringing together the edges of a wound with adhesive layer
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/02—Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/08—Wound clamps or clips, i.e. not or only partly penetrating the tissue ; Devices for bringing together the edges of a wound
- A61B17/085—Wound clamps or clips, i.e. not or only partly penetrating the tissue ; Devices for bringing together the edges of a wound with adhesive layer
- A61B2017/086—Wound clamps or clips, i.e. not or only partly penetrating the tissue ; Devices for bringing together the edges of a wound with adhesive layer having flexible threads, filaments, laces or wires, e.g. parallel threads, extending laterally from a strip, e.g. for tying to opposing threads extending from a similar strip
Abstract
Apparatus for closing a surgical incision comprise a base having left and right panels, a force distribution structure coupled to each panel, and a closure component which releasably attaches to the force distribution structure to draw the inner edges of the panels together in order to close adhered tissue edges. The force distribution structures allow the inner edges of the panels to expand while restraining expansion of the outer edges of the panels and limiting elongation of the lateral dimension of the panels. The incision closure appliance may be placed on skin or other tissue prior to forming the incision to be available to close said incision at the end of the surgical procedure.
Description
background of invention
1. invention field.Present invention relates in general to medical apparatus and instruments and method.More specifically, the present invention relates to be used to form apparatus and the method with closure procedure otch.
The surgical closure device that comprises the adhesive group paster with right panel and left panel is known.The present invention is interested especially, and this class device is described in PCT application US2010/000430 that is common unsettled, that own together, and its whole disclosures are incorporated to herein by reference.As described in this PCT application, adhesion paster is placed in to the position of expectation formation operative incision on patient skin.After placing paster, along the axis extending through paster middle part, form otch.After it forms, can open the operation of otch to expect, and after operation completes, can be by making panel inner edge gather together close incisions with clip, slide fastener or other enclosed member.
The main purpose of this class surgical closure device is to improve healing and reduce the cicatrization being caused by otch.Yet some characteristic of the device that can obtain at present has stoped this object.For example, organization edge does not always gather together along level and smooth line, and this may increase final cicatrization.Many such closing devices do not have the closing force that regulates in organization edge or the ability of distance, thus limited find to reduce cicatrization make the slightly ability of " wrinkling " of tissue.Other shortcoming of the otch that can obtain and Wound closure devices comprises to be used difficulty and can not adapt to the tissue manipulation in subsequent procedures scheme process, that is, its adequate rigidity can not adapt to the movement of tissue in operative process conventionally with those devices of closing tissue securely.
While using below the operative incision drop cloth adhering to, there is special problem in the wound closure paster of certainly adhering.This class drop cloth is for helping to keep at operative process the aseptic of tissue surface, and this class drop cloth can be placed on the tissue closure paster of first prelocalization.When operative incision drop cloth has the adhesion lower surface that can be attached to tissue, this drop cloth will be attached to the upper surface of below tissue closure paster.Therefore removing of operative incision drop cloth can remove or at least mobile tissue closure paster of previously having placed conventionally.If removed or any pith of the closed paster of moving tissue, paster no longer can be used in closure procedure wound.
Due to these reasons, expectation provides improved operative incision closing device and using method thereof.The cut closure device of the controlled closure at adjacent tissue edge after special expectation provides and can be attached to the distortion of organizing in tissue, the formation of permission otch, the operating process of adaptation subsequent procedures and operation is provided.Particularly, if cut closure device can provide the control of closing force in organization edge and be uniformly distributed, the restriction or the stretching, extension that make to be organized in operative process reduce to minimum simultaneously, are desirable.More expectation be to provide improved operative incision closing device and using method thereof, when wherein this device is used below operative incision drop cloth, will prevent from removing or being shifted.The following description of the present invention has met at least a portion in these objects.
2. the explanation of background technology.pCT application US2010/000430 that is common unsettled, that own together is above describing.Other surgical closure device has description in following United States Patent (USP): 2,012,755; 3,516,409; 3,863,640; 3,933,158; 4,114,624; 3,926,193; 4,535,772; 4,676,245; 4,881,546; 4,905,694; 5,377,695; With 7,455,681; And U.S. Patent Publication No. 2005/0020956 and 2008/0114396.Commercialization cut closure device can be from the Ethicon of branch company of Johnson & Johnson with Ethizip
tMthe trade name of interim abdominal wound closing device obtains.
Summary of the invention
The invention provides for closure of wound improved apparatus and the method for the wound that the cutting of particularly carrying out causes in operative process.Otch forms conventionally in patient's skin, for example, through abdominal part, but in some cases also may be on internal organs, in oral cavity, in body cavity etc.
Apparatus and method of the present invention show minimum destruction or interference by the operation technique that otch is formed to laggard row.Particularly, these apparatus and method are opened the opposite edges of the tissue allow cutting, stretch and Free Transforms, and the existence of this closing device causes, are restricted to minimum.Once yet having operated, apparatus and method of the present invention will provide being uniformly distributed of closing force, thereby in the minimum mode of cicatrization, organization edge are gathered together.Especially, this closing device can gather together organization edge with a certain spacing, and when this gap ratio otch forms, the initial spacing existing is slightly more close, to upwards turn up organization edge, causes reducing " gauffer " of cicatrization.
When cut closure apparatus in the time must using below the operative incision drop cloth that this closure apparatus removes, destruction can be avoided or reduce to apparatus and method of the present invention also.In at least a portion of closed apparatus upper surface, be provided with sacrifice layer, sacrifical cap is in position at this, and operative incision drop cloth is placed on cut closure apparatus.In cutting with after operation technique completes, pull-up operative incision drop cloth from patient skin.Surgical drape is not attached on tissue closure apparatus and makes the displacement of tissue closure apparatus, but is attached in sacrifical cap, and only has sacrifical cap in company with drop cloth pull-up from patient, and the remainder of cut closure apparatus is retained in original place.
In a first aspect of the present invention, cut closure apparatus comprises bottom, and this bottom comprises left panel and right panel.Each panel has tissue apposition lower surface, upper surface, inner edge and outer rim.Tissue apposition lower surface generally scribbles conventional tissue apposition binding agent at least in part, as those binding agents that use in operation binder and paster.
This cut closure apparatus further comprise be coupled to each panel power distributed architecture (, on each panel, be coupled with at least one power distributed architecture), wherein each power distributed architecture is suitable for allowing panel along inner edge axial expansion, is limited in lateral expansion in whole length and along the axial expansion of outer rim simultaneously.By allowing panel along inner edge axial expansion, organization edge is subject to minimum constraint, thereby allows to be organized in distortion while stretching in operative process.On the contrary, by limit lateral, expand and along the axial expansion of outer rim, after operation technique completes, when panel gathers together, panel can apply controlled and the closing force distributing, as described in more detail below.
This cut closure apparatus further comprises closing feature or the assembly attaching on power distributed architecture, with after being attached to the tissue of cutting part offside and operation technique at it and completing, panel inner edge is gathered together.It is elastic substrate at least partly that each panel of bottom generally comprises, (this substrate generally have isotropic elasticity, panel stretches in all directions equably), but anisotropic elasticity (its mesostroma preferentially stretches in one direction or in its part) there is alternatively.This elastomeric matrices can comprise elastomer film or sheet (for example, urethane film or thermoplastic elastomer (TPE) (TPE)), Woven fabric (generally at least in part by elastomer yarn, line or fiber weaving), spin fabric etc.In some embodiments, elastomeric matrices can comprise by flexible member (being generally line, silk, fiber etc.) weave and have along outer rim arrange and with the fabric of its crossing non-resilient element extending laterally, to provide above about the extended attribute described in power distributed architecture.In other words, in some cases, power distributed architecture can comprise woven or otherwise introduces the non-resilient element in fabric membrane or be comprised of this non-resilient element.
Conventionally, power distributed architecture will comprise the separate part of cut closure apparatus, for example comprise girder adjacent with panel outer rim, axial arranging and a plurality of axially spaced, side direction is arranged and lateral-supporting thing from girder to panel inner edge that extend from." pectination " structure so is generally formed by flexible but unaugmentable material, thereby makes this element can be crooked together in company with metaplasia, but can, along its length extending, not make them in side direction and along panel outer rim, to provide dimensional stability.The example of this class material comprises nylon, polypropylene, polyethylene and Merlon or other thermopolymer.The power distributed architecture of it should be noted that can not limit the axial stretching, extension of panel inner edge, to the autgmentability of expectation is provided and adapts to tissue in operative process.Independent power distributed architecture like this can be attached to the upper surface of panel, or alternatively can embed or be laminated in panel.Conventionally, power distributed architecture can not extend to or cross the lower surface of panel, makes it can not disturb panel adhering to skin or other tissue.
The assembly of bottom panel and power distributed architecture is generally carried on removable backing, and this backing covers and protect the attaching surface of panel before use.Adhering to backing can be removed, to bottom is applied to skin or other tissue at surgical intervention position.In addition, right panel and left panel are general to keep together with removable fin, axial stay or other removable cover piece or structure, so that panel inner edge keeps predetermined distance or spacing while organizing being attached to.For example, removable fin can be placed in each axial end portion of bottom, two bottom panels are fixed together temporarily.Or removable stay or band can be placed in the end play between right panel and left panel, to panel is held in place relative to one another at Bottomattached during in tissue surface.Such fin or stay are generally from what adhere, and they can be fixed on panel, then after panel is suitably placed, by simple tearing, remove.Then can remove cover piece, fin or stay, so that panel is stayed appropriate location, but not be connected form operative incision between them before.
The first representative configuration of closing feature or assembly comprises right engagement member, left engagement member and keeps a plurality of side direction poles of these engagement member lateral spacing preset distances.Right engagement member is suitable for engaging releasedly along its inner rim the support of right panel, and left engagement member is suitable for engaging releasedly along its inner rim the support of left panel.In specific implementations, at least a portion of the support of power distributed elements has chock near its inner rim, and engagement member has the slit of receiving chock.After surgical intervention completes, closing feature can be placed on power distributed architecture, first the chock in a side is engaged member and engages, and then relative engagement member is pulled on the chock of offside.
Or closing feature or assembly can comprise a plurality of independently side direction pull bars, these pull bars are attached at least a portion of lateral-supporting thing.Such side direction pull bar is configured to be fixed between lateral-supporting thing, is generally fixed on a panel and adjustable ground is attached on another panel.For exemplary embodiment, the attached end of scalable can comprise ratchet retention mechanism or similar structure, and it allows each side direction pull bar with different spacing, to regulate independently between right panel and left panel.Like this, right panel and left panel can along its inner rim difference strain, to control and to optimize the power being applied on the adjacent tissue edge just gathering together.
Alternatively, closed apparatus of the present invention may further include fixed layer, and this fixed layer is adapted at bottom and the assembly of closing feature and is fixed on the otch on patient skin and completes and be placed on this assembly with operation technique.Fixed layer generally has from adhering lower surface, bottom this lower surface of certainly adhering can be placed in and on the assembly of closing feature, with help, is fixed in place and keeps clean.Fixed layer can optionally have opening to allow that disinfectant etc. is observed, sent to wound.
In another aspect of this invention, the method that forms otch in tissue comprises provides cut closure apparatus as above.The right panel of this apparatus and left panel are attached to patient's skin, and the spaced apart previously selected distance of panel inner edge, is generally 0.5mm to 15mm herein.Between panel inner edge in tissue or skin surface form otch (being generally linear), the operation technique of the edge of the tissue then separately cutting to expect.Panel inner edge can stretch along with the movement and distortion of organization edge and adapt to, and that the outer rim of each panel and lateral extension keep is dimensionally stable.After operation completes, closing feature is fixed on power distributed architecture, so that regaining, panel inner edge gathers together.Alternatively, closing feature has the organization edge of making than the size gathering together more closely after otch just forms (or adjustable panel spacing).That organizes turns up edge and tissue " is wrinkled " this gathering, and this can reduce cicatrization.
Accompanying drawing explanation
Fig. 1 is according to the exploded view of the cut closure apparatus of principles of construction of the present invention.
Fig. 2 is the top view of the assembly of bottom and power distributed architecture, and this assembly is a part for cut closure apparatus.
Fig. 3 is the cutaway view of Fig. 2 3-3 along the line.
Fig. 4-7 show cut closure apparatus of the present invention for the application in patient skin formation and close incisions.
Fig. 8 shows the constructive alternative for the closing feature of closed apparatus of the present invention.
Fig. 9 is the exploded view of another embodiment of the cut closure apparatus of constructed in accordance with the principles.
Figure 10 is the bottom of system and the amplification isometric view of power distributed architecture of Fig. 9.
Figure 11 A and 11B show the alternative side direction pulling rod structure that can use in the apparatus of Fig. 1 or Fig. 9.
Figure 12 shows according to the principle of the invention and is positioned the sacrifical cap on cut closure apparatus.
Figure 13 A to 13E shows the operating principle of the sacrifical cap shown in Figure 12 when using together with operative incision drop cloth and implementing method of the present invention.
The specific embodiment
Apparatus of the present invention and method will be used in the formation at operative incision and closing course, and this operative incision forms patient skin or other tissue in operative process.As mentioned below, the direction of otch will define " axially " and " side direction " both, these terms are used in this article.Most of otch will form along common straight line, and this straight line will define axially.Side direction intersects conventionally with axially, is generally but not necessarily perpendicular to axial direction.Most of otch are straight line normally, but in some cases, otch can be curve or have other geometry.Term " axially " is applicable to the direction of the otch of any ad-hoc location, thereby causes side direction also may change.
Referring now to Fig. 1-3,, cut closure apparatus 10 comprises bottom assembly 12, and bottom assembly 12 comprises right panel 14 and left panel 16.Right power distributed architecture 18 is fixed in right panel 14, and normally, by power distributed architecture being laminated to the upper surface of this panel, left power distributed architecture 20 is attached to the upper surface of left panel 16 similarly.This cut closure apparatus further comprises closing feature 22, closing feature 22 can be attached to right power distributed architecture and left power distributed architecture 18 and 20 removedly, so that close incisions, as described in more detail below, and this apparatus comprises optional fixed layer 24, fixed layer 24 can at the bottom assembly 12 of combination and closing feature 22 be fixed to patient and by using this closing feature panel is gathered together and after close incisions, be placed on the bottom assembly 12 and closing feature 22 of combination.
Closing feature 22 is intended to and the inside of be suitable for exerting all one's strength distributed architecture 18 and 20 is inwardly gathered relative to one another, the operative incision having formed between them with closure.In the illustrated embodiment, be formed with a plurality of chocks 26 on lateral-supporting thing 36, lateral-supporting thing 36 is axially kept by the girder 37 of power distributed architecture 18 and 20.Chock 26 is received within the slit 38 forming along the inner edge of the relative bonding member 40 of closing feature 22.Relative engagement member 40 is connected together by side direction pole 42, makes this engagement member keep distance (in other embodiments, isolated distance can regulate) fixing, that lateral spacing is opened.Slit 38 is preferably formed in flexible flap-like structure 44, and flap-like structure 44 allows upwards to pull slit to corresponding chock, so that closing feature 22 is fixed on power distributed architecture 18 and 20.
Each panel 18 and 20 lower surface 32 are generally coated with pressure-responsive binding agent, and this binding agent is coated with protective layer 48 at first, and protective layer 48 divests before use a moment.In addition, can be provided with and be pulled away from fin 50 or other similar structures, so that after removing protective layer 48 but before panel being attached to patient skin or other tissue surface, right panel and left panel 14 and 16 be kept together with the spacing of being scheduled to.Importantly, the distance between each panel 14 and 16 inner edge 28 keeps approaching as far as possible original object spacing, so that organization edge will accurately gather together when being closed parts 22 closure, generally has slight turning up.
Referring now to Fig. 4 to Fig. 7,, will otch formed in accordance with the principles of the present invention and the scheme of close incisions subsequently be described.When starting, after being placed in, right panel and left panel 14 and 16 connect on the patient skin of reference letter S, as shown in Figure 4.By being first pulled away from protective layer 18 and panel being placed in to tissue, apply panel 14 and 16, can remove fin 50 afterwards, leave the otch path 52 limiting between inner edge 28.Select the spacing of inner edge 28 so that fixing, predetermined distance d to be provided
1.
Right panel and left panel 14 and 16 in place after, can use in scalpel or the space of other surgical cutting apparatus CD between panel and form otch I, as shown in Figure 5.
After otch I forms, can carry out operation technique by opening otch inner edge, this makes again inner edge 28 distortion of right panel and left panel 14 and 16, as shown in Figure 6.Because the inner terminal of support 36 is not connected, they are can be freely separated and allow the elastomeric matrices of right panel and left panel 14 and 16 to expand, as shown in Fig. 6 is clear.Yet the dimensional stability of panel remainder is by lateral-supporting thing 36 and axially girder 37 maintenances, the latter can not extend under the impact of opening otch applied force by stretching, extension.
After operation technique completes, closing feature 22 will be fixed on power distributed architecture 18 and 20, as shown in Figure 7.Especially, the slit 38 in flap-like structure 44 engages on relative chock 26, to the opposite edges of panel and tissue cut are gathered together.By suitably separating the degree of depth of slit 38, can customize closing feature 22, make panel 14 and 16 with previously selected apart from d
2gather together.Conventionally, apart from d
2to be less than initial separation d
1, the inner edge of tissue is gathered together, so that organization edge slightly turns up (upwards wrinkling) along otch, this can improve and heals and reduce cicatrization.
Alternatively, as shown in Figure 8, closing feature 22 ' can comprise engagement member 40 ', wherein each side direction pole 42 ' one end by adjustable buckle or other mechanism 54, connect, make relative engagement member 40 ' inner edge between distance can be adjusted, to increase or to reduce the distance d between them
2.
The alternate embodiment 100 of cut closure apparatus of the present invention is shown in Fig. 9 and Figure 10.Apparatus 100 comprises the bottom assembly 102 with right panel 104 and left panel 106.Be provided with location or alignment stay 108 so that the inner edge of each panel is fixed together, as Figure 10 best as shown in, and comprise end flaps 109, it allows user to be placed on tissue surface and from panel 104 and 106, to have pulled off this stay behind appropriate location at panel.
Cut closure apparatus 100 further comprises backing 110, backing 110 has end, and this end can part inflection, to expose the below binding agent that is lining in panel, and make the end of bottom assembly 102 be bonded to tissue, and the remainder of this bottom assembly is still covered by backing.Be provided with the fixed layer 112 that comprises stiffening frame 113, for being placed on after closure on otch on right panel 104 and left panel 106 at bottom assembly 102, contact embodiment is above described conventionally.Conventionally, be provided with pallet 114 for the parts of this apparatus being kept together under aseptic condition, wherein pallet 114 will be coated with conventional medical bag capping.
As shown in Figure 9 and Figure 10, right power distributed architecture 116 and left power distributed architecture 118 are separately positioned on the upper surface of right panel 104 and left panel 106.Right power distributed architecture 116 comprises right axially girder 120 and a plurality of lateral-supporting thing 122.Conventionally, right axially girder 120 comprises the snakelike or herringbone member that embeds or be laminated to bottom stay 121.Snakelike axial girder 120 is generally formed by flexible elastoplast (being generally duroplasts), and bottom stay 121 consists of polyurethane or similar plastic layer.The lower surface of layer of polyurethane will be coated with hydrocolloid layer for tissue apposition.The structure of left power distributed architecture 118 will be identical, comprises that left axially girder 124, left side are to support 126 and bottom left stay 127.
Cut closure apparatus 100 will comprise close mechanism, and this close mechanism comprises a plurality of side direction pull bar assemblies 128, as shown in Figure 9.As shown in Figure 10 the best, each side direction pull bar assembly 128 will comprise that one end is fixed on left side to the connecting rod of support 126 and is fixed on right side to the ratchet mechanism 132 of support 122.Each connecting rod 130 aligns with the axle of left panel 106 parts conventionally, the gap 129 between right panel 104 and left panel 106 is stayed open, thereby can between them, form otch.After otch forms, each connecting rod 130 will be pulled to the ratchet 132 being associated in right panel 104.A series of ratchet rings on each connecting rod will be pulled in the ratchet mechanism 132 being associated, and side draw connecting rod then, until apply the closed tension force of expectation at the point along bottom assembly 102.It is particularly advantageous that each in side direction pull bar assembly 128 can regulate separately the length with the otch along closed to provide the closed tension force of expectation across tissue.Once the closed tension force of expectation is provided along whole otch, just fixed layer 112 can be placed on the assembly 102 of bottom so that apparatus and tissue maintenance in position.
Referring now to Figure 11 A and Figure 11 B,, show the alternative design of side direction pull bar assembly 140 of the present invention.Any in cut closure apparatus 10 or 100 as discussed previously can be used these side direction pull bar assemblies 140.Each side direction pull bar assembly 140 comprises right power distributed architecture 142 and left power distributed architecture 144.Right power distributed architecture comprises right girder 146 and a plurality of lateral-supporting thing 148.Although show three, should be appreciated that and can comprise four, five, six or more lateral-supporting thing.Left power distributed architecture 144 comprises that left girder 150 and a plurality of left side are to support 152 similarly.In order to provide closed, right power distributed architecture 142 comprises the connecting rod 154 extending from central lateral-supporting thing 148.Conventionally, connecting rod 154 is connected to support by live joint or passive joint 158.Draw ring 156 is arranged on the free end of connecting rod 154, and a plurality of hook tooths 162 arrange along the stage casing of connecting rod 154.
Left power distributed architecture 144 comprises ratchet mechanism 160, and ratchet mechanism 160 is suitable for receiving the tooth 162 on the connecting rod 154 of right power distributed architecture.Like this, it is interior with engaging tooth 162 that connecting rod 154 can drop to ratchet 160, thereby connecting rod is pushed ahead, to right power distributed architecture and left power distributed architecture 142 and 144 are gathered together, thereby applies tension force to right panel and left panel.
As shown in figure 12, show another aspect of the present invention.Schematically show cut closure apparatus 100, wherein only show right panel and left panel 104 and 106 and right power distributed architecture and left power distributed architecture 116 and 118.Remaining system unit does not illustrate for the ease of diagram.
Right panel 104 is covered by right sacrifical cap 170, and left panel 106 is covered by left sacrifical cap 172.Each cover piece 170 is removably fixing along each edge of associated bottom panel with 172, makes cover piece be retained in original place in being placed on the process on the tissue surface that will cut in normal process with by cut closure apparatus 100.These sacrifical cap 170 and 172 use and object are described with reference to Figure 13 A and Figure 13 E.
Figure 13 A showed before otch forms right panel and left panel 104 and 106 in place on tissue surface T.Right panel 104 is covered by right sacrifical cap 170, and left panel 106 is covered by left sacrifical cap 172.As in many operations common, will adhere to operative incision drop cloth 180 and be placed on tissue surface T.Can use any conventional drop cloth, for example can be from 3M, St.Paul, the Ioban that Minnesota obtains? antimicrobial otch drop cloth.
After otch drop cloth 180 is in place on cut closure apparatus, can form the surgical intervention of operative incision I to expect.If see, will be through surgical drape 180 between right panel and left panel 104 and 106 cut I respectively.After operation technique completes, from tissue surface T, remove surgical drape 180.Before the present invention, because surgical drape has the lower surface of adhering to, removing of drop cloth may mobile right panel 104 and one of left panel 106 or both.Yet sacrifice layer 170 and 172 existence have stoped this displacement.Removing of surgical drape 180 will remove sacrifice layer 170 and 172, but because each in these layers is configured to relatively low separating force fracture, removing of sacrifice layer can not cause below panel 104 or 106 displacements.Therefore, panel 104 and 106 will be retained in original place, and as shown in Figure 13 D, and power distributed architecture 116 and 118 can be as above for using with as described in close incisions panel is closed together, as shown in Figure 13 E.
Claims (23)
1. a cut closure apparatus, comprising:
Bottom, it comprises left panel and right panel, each panel has tissue apposition lower surface, upper surface, inner edge and outer rim;
Left power distributed architecture and right power distributed architecture, it is coupled to respectively left panel and right panel, and wherein each power distributed architecture is suitable for allowing panel along inner edge axial expansion and restriction and panel intersects ground lateral expansion and along outer rim axial expansion; With
Closed group piece installing, it can be fixed to left panel and right panel, panel inner edge is gathered together after the otch that is attached to tissue at panel and forms betwixt.
2. cut closure apparatus as claimed in claim 1, each panel of wherein said bottom comprises elastomeric matrices.
3. cut closure apparatus as claimed in claim 2, wherein said elastomeric matrices comprises elastomer film, Woven fabric or spinning fabric.
4. cut closure apparatus as claimed in claim 2, wherein said elastomeric matrices comprise by flexible member weave and have along outer rim arrange and with the fabric of its crossing non-resilient element extending laterally.
5. cut closure apparatus as claimed in claim 2, wherein each power distributed architecture comprise girder adjacent with panel outer rim, axial arranging and a plurality of axially spaced, side direction is arranged and lateral-supporting thing from girder to panel inner edge that extend from.
6. cut closure apparatus as claimed in claim 5, wherein said girder and lateral-supporting thing are formed by material flexibility, unaugmentable.
7. cut closure apparatus as claimed in claim 5, wherein said girder and lateral-supporting thing integral body form pectinate texture.
8. cut closure apparatus as claimed in claim 5, wherein said power distributed architecture embeds or is laminated to the upper surface of each panel.
9. cut closure apparatus as claimed in claim 1, further comprises removable space maintainer, and this space maintainer makes right panel and left panel be attached to and keep fixing distance while organizing at them.
10. cut closure apparatus as claimed in claim 9, wherein said removable space maintainer comprises a pair of fin, this is placed in each axial end portion of described bottom removedly to fin.
11. cut closure apparatuses as claimed in claim 9, wherein said removable space maintainer comprises stay, this stay is placed on the end play between right panel and left panel removedly.
12. cut closure apparatuses as claimed in claim 5, wherein said closing feature comprises right engagement member, left engagement member and a plurality of side direction pole, this side direction pole keeps described engagement member lateral spacing to open predetermined distance, wherein said right engagement member is suitable for engaging releasedly along inner edge the support of right panel, and described left engagement member is suitable for engaging releasedly along inner edge the support of left panel.
13. cut closure apparatuses as claimed in claim 12, wherein at least a portion in their support has the chock of close inner edge, and described engagement member has the slit of receiving described chock.
14. cut closure apparatuses as claimed in claim 12, wherein said side direction pole adjustable ground is connected at least one in described engagement member, to allow to regulate predetermined distance.
15. cut closure apparatuses as claimed in claim 5, wherein said closing feature comprises a plurality of independently side direction pull bars, described side direction pull bar is attached at least a portion in described lateral-supporting thing, and wherein said side direction pull bar is configured to be fixed between lateral-supporting thing.
16. cut closure apparatuses as claimed in claim 15, wherein said independently side direction pull bar respectively has one and is fixed to the end of panel and the second end that adjustable ground is attached to another panel.
17. cut closure apparatuses as claimed in claim 16, wherein said the second end comprises ratchet retention mechanism.
18. cut closure apparatuses as claimed in claim 1, further comprise fixed layer, and this fixed layer is suitable for assembly at bottom and closing feature and has been fixed on the otch on patient skin and is placed on this assembly.
19. cut closure apparatuses as claimed in claim 18, wherein said fixed layer has from adhering inner surface.
20. 1 kinds of cut closure apparatuses, comprising:
Bottom, it has upper surface and tissue apposition lower surface, and described bottom is configured to be placed on tissue surface to allow forming otch by this bottom at tissue;
Closing feature, it is configured to the side of panel to gather together with close incisions; With
Sacrifical cap, it covers at least a portion of the upper surface of described bottom, described sacrifical cap is configured between the lower surface that adheres to operative incision drop cloth of the upper surface of described bottom and covering, and when separated with described bottom when described bottom pulls off drop cloth, wherein when removing drop cloth described in bottom can keep being attached to tissue.
21. cut closure apparatuses as claimed in claim 20, wherein said sacrifical cap comprises thin film or the thin slice that is crisply attached to described bottom.
22. cut closure apparatuses as claimed in claim 21, wherein said bottom has isolated edge, and described thin film or thin slice crisply attached along described edge.
23. cut closure apparatuses as claimed in claim 20, described bottom comprises left panel and right panel, but wherein said sacrifical cap comprises and covers respectively each panel do not cover left part and the right part in the gap between described panel, and wherein said gap is used in and in tissue, forms otch.
Applications Claiming Priority (3)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| US13/286,757 | 2011-11-01 | ||
| US13/286,757 US8323313B1 (en) | 2011-11-01 | 2011-11-01 | Surgical incision and closure apparatus with integrated force distribution |
| PCT/US2012/062820 WO2013067024A1 (en) | 2011-11-01 | 2012-10-31 | Surgical incision and closure apparatus with integrated force distribution |
Publications (2)
| Publication Number | Publication Date |
|---|---|
| CN104023648A true CN104023648A (en) | 2014-09-03 |
| CN104023648B CN104023648B (en) | 2016-12-14 |
Family
ID=47226641
Family Applications (1)
| Application Number | Title | Priority Date | Filing Date |
|---|---|---|---|
| CN201280054111.XA Active CN104023648B (en) | 2011-11-01 | 2012-10-31 | There is surgical cut and the Guan Bi apparatus of integrated power distribution |
Country Status (6)
| Country | Link |
|---|---|
| US (1) | US8323313B1 (en) |
| EP (1) | EP2775934B1 (en) |
| JP (1) | JP6181657B2 (en) |
| CN (1) | CN104023648B (en) |
| AU (2) | AU2012332558B2 (en) |
| WO (1) | WO2013067024A1 (en) |
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Also Published As
| Publication number | Publication date |
|---|---|
| EP2775934A1 (en) | 2014-09-17 |
| WO2013067024A1 (en) | 2013-05-10 |
| EP2775934A4 (en) | 2015-09-09 |
| CN104023648B (en) | 2016-12-14 |
| US8323313B1 (en) | 2012-12-04 |
| AU2016202037A1 (en) | 2016-06-09 |
| EP2775934B1 (en) | 2019-10-30 |
| AU2012332558A1 (en) | 2014-05-01 |
| JP6181657B2 (en) | 2017-08-16 |
| AU2016202037B2 (en) | 2017-01-05 |
| AU2012332558B2 (en) | 2016-01-07 |
| JP2014534865A (en) | 2014-12-25 |
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